Provider Demographics
NPI:1407840499
Name:RYDELL, GALE A (MD)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:A
Last Name:RYDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NW 167TH PL
Mailing Address - Street 2:STE 200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-531-2594
Mailing Address - Fax:503-466-1399
Practice Address - Street 1:1960 NW 167TH PL
Practice Address - Street 2:STE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-531-3434
Practice Address - Fax:503-645-4544
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027891Medicaid
105277Medicare ID - Type Unspecified
E93318Medicare UPIN